tbuckley/cabot-search huggingface dataset:
Abstract 11743: Impact of Chronic Kidney Disease / End Stage Renal Disease on Aortic Dissection: Results From the Nationwide Readmission Database
Authors: Joseph Heaton, Sohrab Singh, Dhairya Nanavaty, Pradeep kumar Devarakonda, Farrah Khan, Priyanka Singh, Sarath Reddy, Sourbha Dani
Journal: Circulation (2022)

Introduction: Prior literature has shown that in-hospital and postoperative renal failure are independent mortality predictors in acute aortic dissection (AAD). However, there is limited data on chronic kidney disease (CKD) and end-stage renal disease (ESRD) as pre-existing outcome predictors with AAD Methods: The Nationwide Readmission Database was analyzed from 2016 to 2019 for adult patients admitted with a primary diagnosis of AAD. Patients were assessed for CKD and ESRD. Outcomes were measured for the effect of renal dysfunction on 30-day readmission, inpatient mortality, and length of stay (LOS). Results: Aortic dissection occurred in 45,481 patients over the study period, of which 4727 were readmitted. The mean age was 64 years, and logistical regression analysis revealed that patients with ESRD admitted with AAD were 58% more likely to be readmitted (95% CI [1.29 - 1.93], p&lt;0.001) within 30 days than those without (Figure 1). Notably, ESRD patients had a 30% reduction (95% CI 0.57 - 0.86) in in-patient mortality (Figure 2). Mean LOS was also higher for ESRD patients (6.7 days, 95% CI 5.09 - 8.38) while lower for CKD stage 3-5 (-1.06 days, 95% CI -1.62 --0.50) compared with those without renal disease. Discussion: We observed that patients with ESRD and AAD have higher readmission rates and LOS. However, decreased mortality rates compared with patients with CKD stages 3-5 were observed that could be attributed to increased exposure to healthcare interventions secondary to frequent hemodialysis follow-ups, compared with CKD stages 3-5. Early stages of CKD were excluded, given the possibility of a lack of coding in electronic medical records.
Abstract 12645: Role of Viral Rna-Triggered Innate Immune Activation on Cardiac Arrhythmias Associated With Covid-19
Authors: Deepthi Ashok, Ting Liu, Devin Mair, Laila Stoddart, Kyriakos Papanicolaou, D B Foster, Jason Villano, Deok-Ho Kim, Brian Orourke
Journal: Circulation (2022)

Background: The COVID-19 pandemic has highlighted how little is known about how double stranded RNA (dsRNA) viruses like the SARS-CoV-2 impact cardiac physiology acutely and long-term. While it is unclear if the cardiac effects are direct or indirect, adverse effects in patients are common, including cardiac inflammation, electrophysiological changes in QT interval, atrial fibrillation, bradyarrhythmia, and ventricular tachycardia. Mechanisms underlying these COVID-19-associated arrhythmias are unknown. Methods: We assess the effects of SARS-CoV-2 infection on cardiac electrophysiology and inflammatory pathway activation in a hamster model over a 4-week timespan. We further test if activation of antiviral innate immune responses with a dsRNA mimetic, Poly I:C (PI:C) induces similar effects in uninfected hearts and in human iPSC-derived cardiomyocytes (hiPSC-CMs), examining the determinants of RNAseL activation, interferon (IFN) signaling, and cytokine release in vivo and in vitro. Results: Intranasal SARS-CoV-2 USA-WA1 infection of hamsters caused ECG abnormalities including bradycardia and cardiac conduction defects including sinus pauses, 2 nd and 3 rd degree Atrio-Ventricular block. Bradycardia peaked at 4-5 days after infection. Mean RR interval increased from 182±4ms pre- to 233±6ms post-infection, without significant increases in mock-infected hamsters. In the absence of viral infection, ventricular injection of PI:C induced similar arrhythmias and induction of IFN-stimulated genes. PI:C treatment of hiPSC-CMs induced robust increases in type-I IFN pathway proteins STAT1/pSTAT1, OAS2 (48% increase) and OAS3 (32% increase) and a robust cytokine response. Negative effects on excitation-contraction coupling after 72hr of PI:C treatment, manifested as a 25% reduction in hiPSC-CM Ca 2+ transient peaks. In vitro studies showed increased RNA degradation after PI:C, consistent with activation of the OAS/RNAseL dsRNA sensor pathway. Conclusions: COVID-19 in the hamster model recapitulates a subset of arrhythmias observed in COVID-19 patients. Activation of the viral dsRNA innate immune sensor pathway, even in the absence of active cardiac viral replication, may contribute to SARS-CoV-2-associated cardiac dysfunction.
Abstract 11252: Developing an Interactive Online Curriculum for Teaching Pediatric Electrocardiogram Interpretation
Authors: Shannon Zhang, Alex Kiener, Roberto Gallotti, Troy A Johnston, Eyal Sagiv
Journal: Circulation (2022)

Introduction: Interpretation of pediatric ECGs is a specific skill set that requires familiarity with normal electrographic changes in the developing heart, as well as recognition of a wide range of dysrhythmias or conduction alterations secondary to structural lesions. General pediatricians should use ECGs for various pediatric emergencies, common outpatient concerns and sports participation clearance. Previous studies showed that pediatric trainees are neither comfortable nor proficient in reading ECGs. We developed an interactive self- learning program for teaching pediatric ECG interpretation. Methods: In collaboration between pediatric residents and cardiologists, we created the curriculum, identifying high-yield topics, ‘red flags’ and age- related normal variances that are important to recognize. We built a 5-10-minute teaching module for each topic using Adobe Captivate. The modules were available online on a shared server. Participants were asked to take pre- and post-participation surveys and interpretation skill tests to define knowledge gaps and to focus our curricular development. Results: The pilot curriculum comprised of 14 high-yield topics, general and pediatric- focused. The modules included real ECG samples with multiple-choice questions testing specific electrographic aberrations, followed by audiovisual explanations. The pre-participation survey and test were completed by 57 participants: pediatric residents (59%) and others. Most reported that they do not feel comfortable with distinguishing normal from abnormal ECGs (77.2%), nor recognizing arrhythmias (75.5%) or identifying signs of structural abnormalities (98.3%). The mean test score was 5.13 ± 1.8 out of 10 questions answered correctly, with no significant difference between pediatric residents or other trainees ( p =0.78). Conclusions: We present a newly developed educational program for ECG interpretation that centers on visual learning and pattern recognition of high yield findings in pediatrics. Initial surveys confirm the need for an accessible and engaging teaching tool and we have shared the online modules to be available outside of our institution. We intend to continue and develop the program as more feedback is received.
Abstract 12287: Adipokines and Transitions in Metabolic Risk Over Time: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Bige Ozkan, Sui Zhang, Justin B Echouffo Tcheugui, Roberta Florido, VIJAY NAMBI, Erin D Michos, Layla Abushamat, Kuni Matsushita, Gary Gerstenblith, Roger Blumenthal, Ron C Hoogeveen, Christie M Ballantyne, Josef Coresh, Elizabeth Selvin, Chiadi E Ndumele
Journal: Circulation (2022)

Introduction: Individuals with similar weights have substantial heterogeneity in metabolic risk, a key indicator of cardiovascular disease risk. Additionally, many persons progress from metabolically healthy to metabolically unhealthy status, or regress in metabolic risk, over time. The association of adipokines with transitions in metabolic risk status is unknown. Methods: Among ARIC Visit 2 (1990-92) participants without diabetes, we evaluated the associations of adipokines (adiponectin and leptin; in tertiles) with metabolic risk transitions from Visit 2 to Visit 4 (1996-98; a 6-year interval) among persons with and without obesity using logistic regression. We examined transitions from metabolically healthy (no metabolic syndrome [MetS]) to unhealthy status (MetS, with or without diabetes). Among those with MetS without diabetes at Visit 2, we examined adipokine associations with progression to MetS with diabetes and with regression to metabolically healthy status. Results: Among 7,560 participants, mean age was 57 with 56% female and 17% Black adults. Higher adiponectin levels were associated with about 75% lower risk of progression from metabolically healthy to unhealthy status in those with and without obesity, whereas higher leptin was associated with about 3-fold greater risk of progression (Table, Panel A). Among those with MetS at Visit 2, higher adiponectin was associated with lesser risk of progression to diabetes, and greater likelihood of regression to metabolically healthy status in those with and without obesity (Table, Panel B). Conversely, higher leptin was associated with greater risk of progression to diabetes in those with obesity. Conclusion: Adipokine levels are linked to transitions in metabolic risk status over time among persons with similar weight status. Adipokines may identify individuals at greatest risk of developing metabolic risk factors, who may benefit most from aggressive CVD prevention strategies.
Abstract 12577: Effect of Mavacamten on Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy: Insights From the VALOR-HCM Study
Authors: Paul C Cremer, Jeffrey B Geske, Anjali T Owens, Wael A Jaber, Serge C Harb, Sara Saberi, Andrew Wang, Srihari S Naidu, Hartzell V Schaff, Nicholas G Smedira, Quing Wang, Kathy Lampl, Amy J Sehnert, Steven E Nissen, Milind Y Desai
Journal: Circulation (2022)

Introduction: In the randomized VALOR-HCM study of symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM), mavacamten reduced the need for septal reduction therapy at 16 weeks. Because mavacamten is a cardiac myosin inhibitor that may improve ventricular compliance, this sub-study hypothesized that mavacamten would favorably impact diastolic function. Methods: Symptomatic patients on maximally-tolerated medical therapy referred for septal reduction therapy were randomized 1:1 to mavacamten or placebo. Echocardiographic assessment was performed by an independent, blinded core laboratory. Diastolic grade was determined according to ASE guidelines. Between-group comparisons were made from baseline to week 16. Results: Among 112 enrolled patients, baseline left atrial volume index (LAVi) was similar (Table). At 16 weeks, mavacamten treatment resulted in a significant reduction in LAVi (-5.2 vs -0.5 with placebo, p = .003). Similarly, although lateral E/e’ and septal E/e’ were comparable at baseline, patients treated with mavacamten demonstrated a significant reduction at week 16 (lateral E/e’: -3.5 vs 0.7, p &lt;0.001; septal E/e’: -3.3 vs 0.7, p &lt; 0.001)(Table). Patients treated with mavacamten were also more likely to improve their diastolic dysfunction grade (31.4% vs 12.8%, p = 0.032) (Figure). Conclusions: After only 16 weeks of therapy, in a highly symptomatic oHCM population with echocardiographic-guided drug titration, mavacamten improved measures of diastolic function.
Abstract 11780: Machine Learning Models to Predict Development of CKD and/or HF in Early Stages of Type 2 Diabetes Patients
Authors: Hiroo Tsubota, Toshitaka Yajima, Eiichiro Kanda, Satomi Kanemata, Atsushi Suzuki, Koichi Shirakawa, Masaki Makino
Journal: Circulation (2022)

Chronic kidney disease and/or heart failure (CKD/HF) are the first and most frequent comorbidities that are associated with adverse prognosis in early stages of type 2 diabetes (T2DM) patients. However, efficient screening and risk assessment strategies for the development of CKD/HF remain to be established. We aimed to develop novel machine learning models that can predict the risk of CKD/HF manifestation as well as prognosis in early stages of T2DM patients without a history of CKD or cardiovascular diseases (CVDs). Prediction models were developed with extreme gradient boosting machine (XGB), neural network, logistic regression (LR), and Cox proportional hazards using real-world data of T2DM patients aged ≥18 years without a history of CKD or CVDs (n=217,054) extracted from a Japanese hospital-based administrative claim database. A separate dataset of 16,822 patients from another Japanese database was used for external validation. The outcomes used to construct the models were diagnosis of CKD/HF, hospitalization for CKD/HF and all-cause death during a 5 -year follow-up period. AUROC of XGB and LR for each outcome were as follows. Diagnosis of CKD/HF: 0.777 (XGB); 0.732 (LR), Hospitalization for CKD/HF: 0.785 (XGB); 0.767 (LR), All-cause death: 0.918(XGB) and 0.903(LR). The best-performing XGB models were externally validated; AUROC for diagnosis of CKD/HF , hospitalization for CKD/HF and all-cause death were 0.718 , 0.837 and 0.869 respectively. Furthermore, the Kaplan-Meier curves showed that for both outcomes, the hazard ratio of event-free survival in the group predicted as high-risk and low-risk in the XGB model was statistically significant (Figure). These results demonstrated successful construction of prediction model and using an administrative hospital database and suggest that our model may contribute to early diagnosis and intervention of CKD/HF among early stages of T2DM patients and ultimately improving prognosis of the patients.
Abstract 11159: Assessment of Atrial Cardiomyopathy by High-Density Mapping Can Guide Additional Procedures in AF Ablation
Authors: Seongwook Han, Jongmin Hwang, Hyoung-Seob park
Journal: Circulation (2022)

Background: The efficacy of catheter ablation (CA) for atrial fibrillation (AF) has been lower in persistent AF (PeAF). Additional ablation strategies beyond pulmonary vein isolation (PVI) are not routinely recommended in PeAF because their efficacy is not established yet. The clinical AF patterns could not expect the degree of atrial abnormal voltage area (AVA). The inability to discriminate significant atrial cardiomyopathy may lead to diverse ablation outcomes beyond PVI in PeAF. Objectives: The objective of this study was to find out how much proportion of AVA can predict higher AF recurrence after PVI. Methods: We enrolled the consecutive 49 patients who underwent CA of AF. LA was mapped with Pentaray® catheter (2-6-2 spacing) during mid-CS pacing (600msec) using the CONFIDENCE Module. The peak-to-peak bipolar voltage was obtained using only 2mm spacing electrodes. The AVA was defined when the bipolar voltage was &lt; 1.5mV, which is known to be normal in LA. After excluding PVs, appendage, and mitral valve region, the proportion of AVA was calculated by the Carto 3 mapping system. The ablation strategy was PVI only regardless of the AF pattern &amp; degree of AVA. Results: The mean age was 58.1 ± 7.7 years, and 73.5% were male. The average mapping points were 3557.5 ± 760.9. The average proportion of AVA was 31.4 ± 15.3%. The paroxysmal AF (PAF) patients were 71.4%, and the mean AVA between PAF and PeAF was significantly different (28.7 ± 15.5 vs. 38.2 ± 12.7, p=0.049). The mean follow-up duration was 265.8 ± 150.4 days. Atrial tachyarrhythmia recurred in 35.7%. In receiver-operating curve analysis, the proportion of AVA of 33.4% predicts AF recurrence regardless of AF type with a sensitivity of 75% and specificity of 78.8% (AUC 0.864, P&lt;0.001). Conclusion: More than one-third of AVA assessed by high-density mapping could be used as a predictor of the recurrence of AF after CA, which may guide the consideration of additional ablation. However, a randomized controlled trial is warranted.
Abstract 11818: Daratumumab Containing Regimens Improved Survival in Patients With Light-Chain Cardiac Amyloidosis
Authors: kei morikawa, Mami Morioka, Seiji Takashio, Yawara Kawano, Kenichi Tsujita
Journal: Circulation (2022)

Background: Immunoglobulin light-chain (AL) amyloidosis is a lethal condition resulting from misfolded immunoglobulin ALs produced by clonal CD38-positive plasma cells. Daratumumab, an anti-human CD38 monoclonal antibody, led to higher frequencies of complete hematologic responses and better clinical outcomes compared to conventional treatment. Therefore, daratumumab-containing regimens has become the standard of care in patients with systemic AL amyloidosis and multiple myeloma. This study sought to evaluate the survival benefit of daratumumab-containing regimens in patients with AL cardiac amyloidosis. Methods and Results: We examined 65 consecutive patients with AL cardiac amyloidosis (mean age: 67.2±10.4 years old, male: 69%) who underwent chemotherapy. We divided the patients into two groups, daratumumab group (n=32: treated with daratumumab containing regimens within the first two lines of chemotherapy) and conventional treatment group (n=33). Compared to conventional treatment group, daratumumab group tended to be older (69.2±9.6 vs. 65.2±11.0; p=0.12), while no significant differences in biomarkers and echocardiographic parameters were observed. A total of 26 patients (40%) were deceased (median follow up period: 395 days). Kaplan-Meier survival curves showed that daratumumab group had significantly lower mortality compared to conventional treatment group (p=0.04; log-rank test; Figure). Cox hazard analysis revealed that daratumumab containing regimens were associated with lower mortality after adjustment for revised Mayo staging system for AL amyloidosis (hazard ratio: 0.32; 95% confidence interval: 0.12 to 0.85; p=0.02). Conclusion: Daratumumab containing regimens might be associated with improved survival in AL cardiac amyloidosis.
Abstract 12713: Increased Calcium Sensitivity in Hypoplastic Left Heart Syndrome Hearts With Systolic Failure
Authors: Andrew Shirley, Matthew Stone, Shelley D Miyamoto, Stephanie J Nakano
Journal: Circulation (2022)

Introduction: Systolic failure of the systemic right ventricle (RV) in children with hypoplastic left heart syndrome (HLHS) is a significant cause of death and a growing indication for heart transplantation. However, the underlying etiology of RV systolic failure in this population remains ill-defined. Hypothesis: We hypothesize that cardiomyocyte autonomous defects in contractility, characterized by increased calcium sensitivity, may contribute to systolic failure in HLHS. Methods: Explanted RV tissue was collected and flash frozen at the time of heart transplant in pediatric subjects with HLHS. HLHS subjects were classified by their primary indication for transplant: HLHS subjects with normal systolic function (HLHS-NF, N=2) were transplanted secondary to refractory protein losing enteropathy, and HLHS-F subjects (N=9) had end-stage heart failure due to decreased systolic function. Cardiomyocytes were isolated from frozen RV tissue, permeabilized, and glued to a force transducer and length controller. Force generated by the cardiomyocyte at different calcium concentrations was measured and force-calcium dose response curves were generated (modified Hill equation). pCa50 denotes the negative log of calcium concentration required to generate 50% maximal tension. Results: Less calcium is required to generate 50% maximal tension in HLHS-F cardiomyocytes (n=33 cardiomyocytes) when compared to HLHS-NF (n=5 cardiomyocytes), demonstrated by a higher pCa50 (5.62 vs. 5.46, p=0.027). Maximal force generation is similar between HLHS-NF and HLHS-F cardiomyocytes (55.5 mN/mm2 vs. 54.8 mN/mm2, p=0.96). Conclusions: Cardiomyocytes isolated from HLHS-F demonstrate increased calcium sensitivity when compared to those from HLHS-NF. Although future studies are needed, the presence of intrinsic alterations in sarcomeric properties in HLHS-F supports the hypothesis that cardiomyocyte autonomous defects may contribute to systolic failure in HLHS.
Abstract 12235: Contribution of Individual-Level Factors to Racial and Ethnic Differences in Cardiovascular Health in the United States Population
Authors: Nilay S Shah, Xiaoning Huang, Lucia Petito, Michael Bancks, Hongyan Ning, Natalie Cameron, Kiarri N Kershaw, Namratha Kandula, Mercedes R Carnethon, Donald Lloyd-Jones, Sadiya S Khan
Journal: Circulation (2022)

Introduction: Individual-level factors across several domains underlie racial and ethnic differences in cardiovascular health (CVH). Quantifying the contributions of these determinants to racial and ethnic differences in CVH may inform targeted strategies to mitigate inequities. Methods: In data from NHANES 2011-2018, we calculated mean CVH score (range 0-14; defined by AHA’s Life’s Simple 7 metrics) among US adults ≥20 years. We applied Kitagawa-Blinder-Oaxaca decomposition to quantify the contributions of education, income, food security, marital status, health insurance, place of birth (US vs. foreign born), and depression to racial and ethnic differences in CVH. Results: Among 16,172 participants representing 255 million US adults, 41% were non-Hispanic (NH) White, 23% NH Black, 24% Hispanic, and 12% NH Asian. Among males, mean (SE) CVH score was 7.58 (2.3) in NH White, 7.48 (2.4) in NH Black, 7.45 (2.3) in Hispanic, and 8.71 (2.2) in NH Asian adults. Education explained the largest component of CVH differences in males (if education were similar to NH White, CVH score would be 0.23 [0.03] points higher in NH Black, 0.36 [0.04] points higher in Hispanic, and 0.24 [0.04] points lower in NH Asian, p&lt;0.05; Figure A). Among females, mean (SE) CVH score was 8.00 (2.5) in NH White, 7.43 (2.3) in NH Black, 8.03 (2.4) in Hispanic, and 9.34 (2.1) in NH Asian adults. Education explained the largest component of CVH difference in NH Black females (if education were similar to NH White, CVH score would be 0.17 [0.03] points higher in NH Black, p&lt;0.05; Figure B). Place of birth explained the largest component of CVH difference in Hispanic and NH Asian females (if place of birth were similar to NH White, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively, p&lt;0.05). Conclusion: Education and place of birth confer the largest contributions to the net difference in mean CVH score among racial and ethnic groups in the US.